scholarly journals S241. FACTORS ASSOCIATED WITH EARLY RISK OF DISENGAGEMENT FROM EARLY PSYCHOSIS INTERVENTION SERVICES

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S130-S131
Author(s):  
Nicole Kozloff ◽  
Aristotle Voineskos ◽  
George Foussias ◽  
Alexia Polillo ◽  
Sean Kidd ◽  
...  
Keyword(s):  
At Risk ◽  
Substance Use ◽  
Logistic Regression ◽  
Young People ◽  
Family Involvement ◽  
The Body ◽  
Early Psychosis ◽  
First Episode ◽  
Factors Associated ◽  
Race Ethnicity

Abstract Background Despite the body of evidence supporting early psychosis intervention (EPI) programs for young people with psychotic disorders, approximately 30% of individuals with first-episode psychosis disengage from care. To date, two factors, lack of family involvement and presence of a substance use disorder, have emerged as robust predictors of EPI disengagement. Several factors associated with service disengagement in mental health care more broadly have not been well-studied in EPI; some of these, such as homelessness and ethnicity, may be of particular importance to urban, multicultural populations, and ethnicity in particular has been shown to affect pathways into EPI services. Early missed appointments may signal risk for subsequent service disengagement. We sought to identify early predictors of disengagement risk in an urban EPI program. Methods We conducted a prospective chart review of consecutive patients accepted for services in a large, urban EPI program in Toronto, Canada in a 3-month period from July 4-October 3, 2018. Patients were observed in their first 3 months of treatment. The primary outcome of interest was risk of disengagement, defined as having missed at least 1 appointment without cancellation. Extracted data included a variety of demographic and clinical information. The principal investigator trained 2 data abstractors on the first 50 charts; subsequent agreement on the next 5 charts was 88%. Based on previous literature, we hypothesized that risk of disengagement would be increased in individuals with problem substance use, experiences of homelessness, and nonwhite race/ethnicity and decreased in individuals with family involvement in their care. We used logistic regression to examine the odds of disengagement associated with univariate predictors individually, and then together in a multivariate model. Results Seventy-three patients were consecutively admitted to EPI services in the 3-month period. Of these individuals, 59% (N=43) were identified as being at risk of disengagement based on having missed at least 1 appointment without cancellation. In the full sample, 71% (N=52) identified as nonwhite, 23% (N=17) had a documented experience of homelessness, 52% (N=38) had problem substance use, and 73% (N=53) had family involved in their care. In univariate logistic regression, only problem substance use was associated with risk of disengagement (OR=2.91, 95% CI 1.11–7.66); no significant associations were identified with race/ethnicity, experience of homelessness, or family involvement. In multivariate logistic regression, once we controlled for these other factors, the association between risk of disengagement and problem substance use was attenuated and no longer statistically significant (OR=2.15, 95% CI 0.77–5.97). Discussion In this small study of early disengagement in an urban EPI program, only problem substance use was associated with increased odds of missing an appointment, but not when we controlled for other factors thought to be associated with disengagement. Larger studies may be required to identify factors with small but important effects. These factors may be used to identify young people at risk of disengagement from EPI services early in care in order to target them for increased engagement efforts.

Suicide Prevention in First Episode Psychosis: The Development of a Randomised Controlled Trial of Cognitive Therapy for Acutely Suicidal Patients With Early Psychosis

2003 ◽  
Vol 37 (4) ◽  
pp. 414-420 ◽  
Author(s):  
P.J.R. Power ◽  
R.J. Bell ◽  
R. Mills ◽  
T. Herrman-Doig ◽  
M. Davern ◽  
...  
Keyword(s):  
Early Intervention ◽  
Treatment Group ◽  
Young People ◽  
Controlled Trial ◽  
First Episode Psychosis ◽  
Early Psychosis ◽  
First Episode ◽  
Episode Psychosis ◽  
Randomised Controlled ◽  
Suicidal Patients

Background: Young people with early psychosis are at particularly high risk of suicide. However, there is evidence that early intervention can reduce this risk. Despite these advances, first episode psychosis patients attending these new services still remain at risk. To address this concern, a program called LifeSPAN was established within the Early Psychosis Prevention and Intervention Centre (EPPIC). The program developed and evaluated a number of suicide prevention strategies within EPPIC and included a cognitively oriented therapy (LifeSPAN therapy) for acutely suicidal patients with psychosis. We describe the development of these interventions in this paper. Method: Clinical audit and surveys provided an indication of the prevalence of suicidality among first episode psychosis patients attending EPPIC. Second, staff focus groups and surveys identified gaps in service provision for suicidal young people attending the service. Third, a suicide risk monitoring system was introduced to identify those at highest risk. Finally, patients so identified were referred to and offered LifeSPAN therapy whose effectiveness was evaluated in a randomised controlled trial. Results: Fifty-six suicidal patients with first episode psychosis were randomly assigned to standard clinical care or standard care plus LifeSPAN therapy. Forty-two patients completed the intervention. Clinical ratings and measures of suicidality and risk were assessed before, immediately after the intervention, and 6 months later. Benefits were noted in the treatment group on indirect measures of suicidality, e.g., hopelessness. The treatment group showed a greater average improvement (though not significant) on a measure of suicide ideation. Conclusions: Early intervention in psychosis for young people reduces the risk of suicide. Augmenting early intervention with a suicide preventative therapy may further reduce this risk.

scholarly journals A Novel Landscape for Understanding Physical and Mental Health: Body Mapping Research with Youth Experiencing Psychosis

2018 ◽  
Vol 3 (2) ◽  
pp. 236-261 ◽  
Author(s):  
Katherine M. Boydell ◽  
Jeffrey Ball ◽  
Jackie Curtis ◽  
Adèle De Jager ◽  
Megan Kalucy ◽  
...  
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Young People ◽  
Physical Health ◽  
Social Issues ◽  
The Body ◽  
First Episode ◽  
Physical And Mental Health ◽  
Body Mapping ◽  
The Future

Estimates indicate the lifespan of individuals with psychotic illness is reduced by approximately 15-20 years. Consequently there is a need to address the physical health of those who live with a mental illness, like psychosis. The Bondi Centre provides an integrated model of care to young people with a first episode of psychosis. The Keeping the Body In Mind program focuses on prevention and early intervention of physical health issues and is offered alongside treatment for mental health and social issues as part of routine care. We used body mapping, an arts-based research method, to explore the complexity of this physical health intervention. Our aim was to develop an in-depth understanding of experiences of young clients of the early intervention centre, with a particular focus on the embodied relationship between physical and mental health. Six young people engaged in creating life-sized body maps depicting their experience of the physical intervention program over four 3-hour sessions, followed by an in-depth interview. Analysis of our body maps drew on thematic analysis and narrative inquiry. The narrative trope was one of recovery, highlighting the importance of the link between body and mind, individual and community, and the balance between light and darkness. There was an emphasis on developing feelings of connectedness (to self and others), hope and optimism for the future, a sense of having an identity, and a sense of meaning and empowerment. Recovery was conceptualised as an ongoing process rather than an end product or fixed state. Involvement in the body mapping process was consistently identified as therapeutic, offering an opportunity for reflection on the journey to recovery with a focus on past, present and imagined storylines of the future. 

scholarly journals Multi-Dimensional Factors Associated with Illegal Substance Use Among Gay and Bisexual Men in Taiwan

2019 ◽  
Vol 16 (22) ◽  
pp. 4476 ◽  
Author(s):  
Dian-Jeng Li ◽  
Shiou-Lan Chen ◽  
Cheng-Fang Yen
Keyword(s):  
Substance Use ◽  
Logistic Regression ◽  
Early Adulthood ◽  
Gay And Bisexual Men ◽  
Stepwise Logistic Regression ◽  
Childhood And Adolescence ◽  
Bisexual Men ◽  
Cross Sectional ◽  
Factors Associated ◽  
And Bisexual

Illegal substance use in sexual minorities is an important health issue worldwide. The present cross-sectional study aimed to investigate the multi-dimensional factors associated with illegal substance use among gay and bisexual men in Taiwan. This questionnaire-survey study recruited 500 gay or bisexual men aged between 20 and 25 years. Their experiences of using eight kinds of illegal substances in the preceding month were collected. Their previous experiences of homophobic bullying, satisfaction with academic performance, truancy, perceived family and peer support in childhood and adolescence, and social-demographic characteristics, were also collected. Potential factors associated with illegal substance use were identified using univariate logistic regression, and further selected into a forward stepwise logistic regression model to identify the factors most significantly related to illegal substance use. A total of 22 (4.4%) participants reported illegal substance use in the preceding month, and mean age was 22.9 ± 1.6. Forward stepwise logistic regression revealed that being victims of homophobic cyberbullying in childhood and adolescence (odds ratio (OR) = 1.26; p = 0.011), disclosure of sexual orientation at junior high school (OR = 4.67; p = 0.001), and missing classes or truancy in senior high school (OR = 2.52; p = 0.041) were significantly associated with illegal substance use in early adulthood. Multi-dimensional factors in childhood and adolescence that were significantly associated with illegal substance use in early adulthood among gay and bisexual men were identified. Besides traditional bullying, the effect of cyberbullying and school performance on illegal substance use should not be ignored. This study is limited to the cross-sectional design and possible recall bias. Mental health professionals must routinely assess these significant factors to prevent and intervene in illegal substance use among gay and bisexual men.

scholarly journals Transactional Sex With Regular and Casual Partners Among Young Men Who Have Sex With Men in the Detroit Metro Area

2015 ◽  
Vol 11 (3) ◽  
pp. 498-507 ◽  
Author(s):  
José A. Bauermeister ◽  
Lisa Eaton ◽  
Steven Meanley ◽  
Emily S. Pingel ◽  
Keyword(s):  
Substance Use ◽  
Employment Status ◽  
Young Men ◽  
The Body ◽  
Transactional Sex ◽  
Relationship Status ◽  
Cross Sectional Survey ◽  
Metro Area ◽  
Race Ethnicity ◽  
Sex With Men

Transactional sex refers to the commodification of the body in exchange for shelter, food, and other goods and needs. Transactional sex has been associated with negative health outcomes including HIV infection, psychological distress, and substance use and abuse. Compared with the body of research examining transactional sex among women, less is known about the prevalence and correlates of transactional sex among men. Using data from a cross-sectional survey of young men who have sex with men (ages 18-29) living in the Detroit Metro Area ( N = 357; 9% HIV infected; 49% Black, 26% White, 16% Latino, 9% Other race), multivariate logistic regression analyses examined the association between transactional sex with regular and casual partners and key psychosocial factors (e.g., race/ethnicity, education, poverty, relationship status, HIV status, prior sexually transmitted infections [STIs], mental health, substance use, and residential instability) previously identified in the transactional sex literature. Forty-four percent of the current sample reported engaging in transactional sex. Transactional sex was associated with age, employment status, relationship status, and anxiety symptoms. When stratified, transactional sex with a regular partner was associated with age, educational attainment, employment status, relationship status, anxiety, and alcohol use. Transactional sex with a casual partner was associated with homelessness, race/ethnicity, employment status, and hard drug use. The implications of these findings for HIV/STI prevention are discussed, including the notion that efforts to address HIV/STIs among young men who have sex with men may require interventions to consider experiences of transactional sex and the psychosocial contexts that may increase its likelihood.

Factors Associated with the History of Attempted Suicide

Crisis ◽  
2010 ◽  
Vol 31 (1) ◽  
pp. 12-21 ◽  
Author(s):  
A. Hakansson ◽  
L. Bradvik ◽  
F. Schlyter ◽  
M. Berglund
Keyword(s):  
Substance Use ◽  
Logistic Regression ◽  
Criminal Justice ◽  
Family History ◽  
Binge Drinking ◽  
Emotional Abuse ◽  
Psychiatric Symptoms ◽  
Addiction Severity Index ◽  
Factors Associated ◽  
History Of

Background: The present study examines a population of criminal justice clients for suspected substance-related problems. Aims: It aims to identify variables associated with a history of suicide attempt (SA). Method: 6,836 clients were interviewed with the Addiction Severity Index (ASI). Attempters were compared to nonattempters regarding substance use, medical/psychiatric status, family history, and social relationships in a stepwise forward logistic regression. Results: Attempters (21%) were more likely to report binge drinking, intake of illicit drugs, injection of drugs, physical and mental illness, problematic family history, and history of being abused. After logistic regression, SA was independently associated with older age, female gender, binge drinking, delirium tremens, injection, overdose, medical problems, psychiatric symptoms, family history of alcohol or psychiatric problems, and sexual, physical, and emotional abuse. The psychiatric and family/social domains (including being abused) most strongly separated attempters from nonattempters. Conclusions: Family background factors, psychiatric symptoms, severity of substance use, and sexual, physical, and emotional abuse appear to be factors associated with SA among criminal justice clients.

scholarly journals Disparities in Access to Early Psychosis Intervention Services: Comparison of Service Users and Nonusers in Health Administrative Data

2018 ◽  
Vol 63 (6) ◽  
pp. 395-403 ◽  
Author(s):  
Kelly K. Anderson ◽  
Ross Norman ◽  
Arlene G. MacDougall ◽  
Jordan Edwards ◽  
Lena Palaniyappan ◽  
...  
Keyword(s):  
Administrative Data ◽  
First Episode Psychosis ◽  
Early Psychosis ◽  
Primary Data ◽  
First Episode ◽  
Health Administrative Data ◽  
Lower Odds ◽  
Factors Associated ◽  
Episode Psychosis ◽  
Incident Cases

Objective: There is a dearth of information on people with first-episode psychosis who do not access specialized early psychosis intervention (EPI) services. We sought to estimate the proportion of incident cases of nonaffective psychosis that do not access these services and to examine factors associated with EPI admission. Methods: Using health administrative data, we constructed a retrospective cohort of incident cases of nonaffective psychosis in the catchment area of the Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario, between 1997 and 2013. This cohort was linked to primary data from PEPP to identify EPI users. We used multivariate logistic regression to model sociodemographic and service factors associated with EPI admission. Results: Over 50% of suspected cases of nonaffective psychosis did not have contact with EPI services for screening or admission. EPI users were significantly younger, more likely to be male (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.24 to 2.01), and less likely to live in areas of socioeconomic deprivation (OR 0.51; 95% CI 0.36 to 0.73). EPI users also had higher odds of psychiatrist involvement at the index diagnosis (OR 7.35; 95% CI 5.43 to 10.00), had lower odds of receiving the index diagnosis in an outpatient setting (OR 0.50; 95% CI 0.38 to 0.65), and had lower odds of prior alcohol-related (OR 0.42; 95% CI 0.28 to 0.63) and substance-related (OR 0.68; 95% CI 0.50 to 0.93) disorders. Conclusions: We need a greater consideration of patients with first-episode psychosis who are not accessing EPI services. Our findings suggest that this group is sizable, and there may be sociodemographic and clinical disparities in access. Nonpsychiatric health professionals could be targeted with interventions aimed at increasing detection and referral rates.

scholarly journals Giving women WOICE postpartum: prevalence of maternal morbidity using the WHO-WOICE instrument

2019 ◽  
Author(s):  
Lamus MN ◽  
Stephanie Lozano ◽  
Charles CM ◽  
Guida JP ◽  
Parpinelli MA ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Logistic Regression ◽  
Descriptive Analysis ◽  
Perinatal Outcomes ◽  
Good Health ◽  
World Health ◽  
Anxiety And Depression ◽  
Cross Sectional ◽  
Factors Associated

Abstract Background There are no accurate estimates of the prevalence of non-severe maternal morbidities. Given the lack of instruments to fully assess these morbidities, the World Health Organization (WHO) developed an instrument called WOICE. Objective To evaluate the prevalence of non-severe maternal morbidities in puerperal women and analyses factors associated to impaired clinical, social and mental health conditions. Method A cross-sectional study with 519 postpartum women in a single encounter 6 to 12 weeks postpartum. The WOICE questionnaire included three sections: the first with maternal and obstetric history, sociodemographic data, risk and environment factors, violence and sexual health; The second considers functionality and disability, general symptoms and mental health; and the third includes data on physical and laboratory tests. Data collection was supported by Tablets with REDCAP software. Initially, a descriptive analysis was performed, with general prevalence of all variables contained in the WOICE, including scales on anxiety and depression (GAD-7 and PHQ-9- altered if ≥10), functionality (WHODAS- altered when ≥37.4) and data on violence and substance use. Subsequently, an evaluation of cases with alterations was performed, with a logistic regression to investigate factors associated to impaired non-clinical and clinical conditions. Results 517 women were included, majority (54.3%) multiparous, ages between 20 and 34 years (65.4%) and with partner (75,6%). Over a quarter had (26.2%) preterm birth, however good perinatal outcomes. Around a third (30.2%) reported health problems informed by the physician, although more than 80% considered having good or very good health. About 10% reported any substance and 5.9% suffered violence. Anxiety was identified in 19.8% of cases, depression in 36.9% and altered functioning in 4.4% of women. Logistic regression identified that poor overall health rating was associated to increased anxiety/depression and impaired functioning. Having a partner reduces the perception of women on the presence of clinical morbidities. Conclusion During postpartum care, women presented high frequency of anxiety and depression and relevant frequency of substance use and violence. These aspects of women´s health need further evaluation and specific interventions to improve quality of care.

scholarly journals Is age and not antiretroviral therapy the strongest risk factor for chronic pain in HIV-infected population?

2021 ◽  
Author(s):  
Marcin Kowalski ◽  
Andrzej Horban ◽  
Witold Rongies ◽  
Bartosz Slomka ◽  
Karen Shahnazaryan
Keyword(s):  
Chronic Pain ◽  
Logistic Regression ◽  
Risk Factor ◽  
Antiretroviral Therapy ◽  
Pain Treatment ◽  
Hiv Treatment ◽  
The Body ◽  
Survey Study ◽  
Specialist Care ◽  
Factors Associated

Abstract Background. Chronic pain in HIV-infected patients on effective antiretroviral therapy (ART) limits patients’ normal functioning both somatically and psychologically. The current state of knowledge on the topic is insufficient, with the underlying causes of this pain unexplained. Therefore we analyzed the frequency and factors associated with chronic pain in HIV-infected patients on ART.Methods. We conducted a prospective, survey study, including consecutive HIV-infected patients under specialist care at the HIV Outpatient Clinic of the Hospital for Infectious Disease in Warsaw between February 2014 and December 2016. During their routine visit all patients who agreed to participate in the study were surveyed using a study questionnaire. For all patients reporting any pain the Brief Pain Inventory (BPI) form and Douleur Neuropathique 4 Questions form (DN4) were completed. Data on history and current ART and laboratory measurements were obtained from electronical database. Chi-squared and Kruskal-Wallis tests were used for group comparison. The potential factors associated with chronic pain were identified via logistic regression models. Results. In total 196 HIV-infected patients were included in the study, 57 (29,1%) of them reported chronic pain. The reported pain was mostly (75%) limited to a single area of the body. In univariable logistic regression model the odds of chronic pain were significantly higher with increasing age (OR 1.36 [95%CI:1.17-1.58]), time under specialist care (OR 2.25 [95%CI:1.42-35.7]), time on ART (OR2.96 [95%CI:1.60-5.49]), previous ART with zidovudine (OR 2.00[95%CI:1.06-1.55]) and previous treatment with ddI, ddC or d4T (OR4.13 [95%CI:1.92-8.91]). Homosexual route of HIV infection as compared to injecting drug use was decreasing the odds of chronic pain (OR0.33 [95%CI: 014-0.75]). In multivariable analyses, adjusting for all above the only factor associated with chronic pain was age (OR1.28 [95%CI:1.06-1.55]). Conclusions. The prevalence of chronic pain in the studied population of HIV-infected Polish patients was high. The only risk factor for chronic pain identified was age. With ageing HIV population it is therefore imperative to develop cooperation protocols for specialist HIV treatment clinics, pain treatment clinics, and rehabilitation units.

scholarly journals Giving women WOICE postpartum: Prevalence of maternal morbidity using the WHO-WOICE instrument

2020 ◽  
Author(s):  
Martha Narvaez Lamus ◽  
Stephanie Lozano ◽  
Charles MPoca ◽  
Jose Paulo Guida ◽  
Mary Angela Parpinelli ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Logistic Regression ◽  
Descriptive Analysis ◽  
Perinatal Outcomes ◽  
Good Health ◽  
World Health ◽  
Anxiety And Depression ◽  
Cross Sectional ◽  
Factors Associated

Abstract BackgroundThere are no accurate estimates of the prevalence of non-severe maternal morbidities. Given the lack of instruments to fully assess these morbidities, the World Health Organization (WHO) developed an instrument called WOICE.ObjectiveTo evaluate the prevalence of non-severe maternal morbidities in puerperal women and analyses factors associated to impaired clinical, social and mental health conditions.MethodA cross-sectional study with 519 postpartum women in a single encounter 6 to 12 weeks postpartum. The WOICE questionnaire included three sections: the first with maternal and obstetric history, sociodemographic data, risk and environment factors, violence and sexual health; The second considers functionality and disability, general symptoms and mental health; and the third includes data on physical and laboratory tests. Data collection was supported by Tablets with REDCAP software. Initially, a descriptive analysis was performed, with general prevalence of all variables contained in the WOICE, including scales on anxiety and depression (GAD-7 and PHQ-9- altered if ≥ 10), functionality (WHODAS- altered when ≥ 37.4) and data on violence and substance use. Subsequently, an evaluation of cases with alterations was performed, with a logistic regression to investigate factors associated to impaired non-clinical and clinical conditions.Results517 women were included, majority (54.3%) multiparous, ages between 20 and 34 years (65.4%) and with partner (75,6%). Over a quarter had (26.2%) preterm birth, however good perinatal outcomes. Around a third (30.2%) reported health problems informed by the physician, although more than 80% considered having good or very good health. About 10% reported any substance and 5.9% suffered violence. Anxiety was identified in 19.8% of cases, depression in 36.9% and altered functioning in 4.4% of women. Logistic regression identified that poor overall health rating was associated to increased anxiety/depression and impaired functioning. Having a partner reduces the perception of women on the presence of clinical morbidities.ConclusionDuring postpartum care, women presented high frequency of anxiety and depression and relevant frequency of substance use and violence. These aspects of women´s health need further evaluation and specific interventions to improve quality of care.

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